Provider Demographics
NPI:1730151630
Name:PHYSICAL THERAPY CENTER OF WOODBRIDGE, PC
Entity type:Organization
Organization Name:PHYSICAL THERAPY CENTER OF WOODBRIDGE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC TRES
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-750-9286
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-0567
Mailing Address - Country:US
Mailing Address - Phone:732-750-9286
Mailing Address - Fax:732-750-9225
Practice Address - Street 1:1500 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1000
Practice Address - Country:US
Practice Address - Phone:732-750-9286
Practice Address - Fax:732-750-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA02309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ052969Medicare ID - Type Unspecified